RPM Manual
The practical 2026 guide to device rules, day thresholds, management time, and audit defensibility for Remote Patient Monitoring.
Read the RPM Guide →Build APCM + Behavioral Health + RPM/RTM on One Operational Spine
APCM is a monthly, non-time-based bundle (G0556–G0558). In 2026, CMS added optional behavioral-health add-ons under the same practitioner/month and modernized remote-monitoring payment. This page shows how to wire the workflows so you can bill cleanly and prove continuity. [1]
Citations: CMS final rule, CMS APCM page, MLN.
What must exist in your operating model
Why APCM is the “home base”
APCM pays monthly for longitudinal primary care without minute tracking; you select one of three base HCPCS codes (G0556, G0557, G0558) by complexity when monthly requirements are met (consent, initiating visit rule, 24/7 access/continuity, comprehensive care plan, population-level management). [1]
Behavioral-health inside APCM
CMS finalized three optional APCM add-on G-codes for behavioral-health integration/collaborative care that must be billed in the same month by the same practitioner who reports the APCM base code; the services are directly comparable to existing CoCM/BHI codes. CMS also adopted these add-ons for RHCs/FQHCs furnishing advanced primary care. [2]
Remote monitoring in parallel
For 2026, CMS modernized remote-monitoring payment and will use OPPS data to inform some PFS rates for remote monitoring services; new RPM/RTM codes capture shorter data windows and shorter management increments (e.g., less-than-16-day device windows and 10-minute management codes). [2]
Guardrails that still apply
Current MLN guidance: only one practitioner can bill RPM for a patient in a 30-day period and RPM can’t be billed together with RTM; management codes have distinct rules. Use new 2026 codes where applicable, but retain MLN guardrails unless CMS updates them. [3]
The platform architecture
A single operational spine with four layers you can configure in your EMR or care-management software.
Layer A -- Panel & continuity core (APCM)
- Patient attribution to a designated clinician/team; continuity and 24/7 access policies enforced at scheduling and triage.
- APCM Monthly Note object with care-plan spine (problems/goals, meds reconciliation, transitions, population-level gaps, CEHRT measures). [1]
Layer B -- Behavioral-health channel (APCM add-on)
- Inside the APCM month, embed BHI/CoCM activities (screenings, care-manager workflows, case review) so the same practitioner can add the BH code in-month. [2]
Layer C -- Monitoring channel (RPM/RTM)
- Independent evidence pack: device-day logs (2–15 or 16–30), interaction minutes (10–19 or 20+), alerts and clinical actions.
- Keep artifacts distinct from APCM documentation to avoid double-counting.
Layer D -- Pre-claim validator
- Rule set checks: BH add-on requires APCM base same month/same practitioner.
- RPM/RTM evidence meets day/time thresholds.
- “Only one RPM practitioner/30 days” enforced; RPM and RTM not billed together.
- Supervision policy enforced, including permanent virtual direct supervision where applicable. [2, 3]
Documentation map (what lives where)
APCM Monthly Note
- Consent status and initiating-visit logic.
- Continuity/access attestations (24/7 urgent access, designated clinician/team). [1]
- Comprehensive care-plan updates: problems/goals, medications, self-management, transitions, population management, performance reporting hooks.
APCM behavioral-health add-on entry
- Screening instruments, care-manager notes, case review cadence, outcomes tracking.
- Tied to the APCM month and the same practitioner as the base code. [2]
RPM/RTM evidence pack
- Device assignment, medical necessity statement, day-count, time-log, outreach attempts, escalation notes.
- Stored as a separate artifact referenced by the APCM month (when relevant), not embedded inside the APCM note.
Minimal data model (practice-ready)
You can implement this in a spreadsheet, EMR data layer, or care-management tool. The key is consistency.
Panel patient_id attributed_practitioner_id attribution_start attribution_end (NULL if active) Continuity_ledger patient_id month continuity_touch_count urgent_access_flag designated_clinician_seen_flag [1] APCM_month patient_id month selected_code (G0556 | G0557 | G0558) consent_ptr initiating_visit_ptr careplan_ptr transitions_ptr population_metrics_ptr bh_addon_code (NULL | G0568 | G0569 | G0570) bh_payload_ptr [1], [2] RPM_month / RTM_month patient_id month device_family days_captured_range (2–15 | 16–30) time_bucket (10–19 | 20+) clinical_actions_json practitioner_id Claim_precheck patient_id month rules_results_json // pass/fail per rule with rationale
Operating rules that prevent denials
Same-practitioner BH add-on rule
APCM base and BH add-on must share practitioner and month; block cross-practitioner scenarios before claims go out. [2]
Distinct-work rule
Don’t double-count APCM activities as RPM/RTM work. Require separate artifacts and links (APCM note vs monitoring evidence). [2]
RPM exclusivity & pairing
Enforce “one RPM practitioner per 30 days”; prevent RPM and RTM together. If 2–15-day codes are used, map each claim to the code that matches the documented window and management time. [3]
Supervision
Apply permanent virtual direct supervision definitions for applicable services; highlight services where it does not apply and ensure supervising practitioner documentation is clear. [2]
Continuity-weighted planning (optional)
Define a continuity factor wt ∈ [0,1] per patient/month and use it only for forecasting and incentives--not for eligibility or code selection.
- Inputs: APCM streak months, RPM device adherence, timely follow-ups, documented touches.
- Use wt to project panel revenue and guide team incentives (e.g., how a +10% or +20% engagement shift moves projected revenue).
- Keep coding decisions purely criteria-based; this is a planning lens, not a compliance rule.
Implementation blueprint (what you get when you opt in)
Policy matrix
- Rows for: APCM alone; APCM + BH add-on; APCM + RPM; APCM + BH + RPM.
- Columns for: “Permitted/conditions”, “Required documentation elements”, “Gotcha checklist”.
- Citations inline to CMS APCM page, CY 2026 fact sheet, MLN for each intersection. [1], [2], [3]
Workflow swimlane
- Attribution → APCM monthly review → BH screen/case review → monitoring review → pre-claim validator → claim.
- Role clarity: which steps belong to clinicians, care managers, coders, and billers.
Config scripts
Validator rules expressed as JSON/YAML (e.g., bh_addon_requires_apcm, rpm_single_practitioner, rpm_days_threshold) that can be imported into your RCM audit layer or FairPath’s compliance engine.
Get the Implementation Blueprint
We’ll email you the policy matrix, swimlane, and sample validator rules as a single PDF.
Talk through your configuration
Book a 20-minute session focused on APCM + BHI + RPM/RTM intersections for your practice.
Book a 20-minute demoFAQ
Yes--if the same practitioner who bills the APCM base code also bills the add-on in that month. CMS designed the BH add-ons as integrated APCM services.
[2]
Yes, when each service independently meets criteria and documentation is distinct. Use the new short-window/time codes where applicable in 2026 and keep APCM care-plan work separate from monitoring evidence.
[2]
New 2026 RPM/RTM codes enable shorter windows (e.g., 2–15 days) with their own thresholds and payment. Use those codes when the evidence supports the shorter window. Baseline MLN rules (one RPM practitioner per 30 days; no RPM + RTM together) still apply unless CMS updates the MLN.
[2, 3]
CMS finalized permanent virtual direct supervision for applicable services (excluding audio-only). Ensure each service you pair with APCM/RPM/RTM meets the supervision definition and that the supervising practitioner is documented.
[2]
Citations
- CMS APCM Page -- APCM definition, monthly bundle, base codes G0556–G0558, core requirements [1]
- CMS CY 2026 PFS Final Rule Fact Sheet -- APCM BH add-ons, remote monitoring changes, efficiency adjustment, supervision [2]
- CMS MLN Telehealth & Remote Patient Monitoring (MLN901705) -- RPM practitioner/30 days; RPM vs RTM constraints [3]
- Center for Connected Health Policy -- PFS final rule summaries (APCM BH codes, new RPM/RTM codes)
Summarizes CMS public materials. Always confirm with your MAC and payer bulletins. Where 2026 codes introduce new windows/time increments, select CPTs that match your evidence.
